COMPREHENSIVE CARE JOINT REPLACEMENT MODEL (CJR)

Transcription

1 COMPREHENSIVE CARE JOINT REPLACEMENT MODEL (CJR)

2 Comprehensive Care for Joint Replacement Model (CJR) CJR is focused on elective primary hip and knee replacement patients. It begins on April 1, 2016, and will run for 5 years. The model includes inpatient stay and postoperative care 90 days after discharge. Unlike other innovative models, CJR requires that all IPPS hospitals in the selected MSAs participate. The average Medicare payment for hip and knee procedures ranges from $16,500 to $33,000, according to CMS. Medicare estimates a cost savings of $153 million over the 5 years of the model. 2

3 CJR: Need to Know 1 Are you in a selected metropolitan area? Do you see elective primary hip and knee replacement patients in your practice? What are your costs per episode for this patient population? What are your outcomes for this patient population? Would your practice benefit from engaging as a collaborator in CJR?

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5 Akron, OH Gainesville, GA Ogden-Clearfield, UT Albuquerque, NM Greenville, NC Oklahoma City, OK Asheville, NC Harrisburg-Carlisle, PA Orlando-Kissimmee-Sanford, FL Athens-Clarke County, GA Hot Springs, AR Pensacola-Ferry Pass-Brent, FL Austin-Round Rock, TX Indianapolis-Carmel-Anderson, IN Pittsburgh, PA Beaumont-Port Arthur, TX Kansas City, MO-KS Port St. Lucie, FL Bismarck, ND Killeen-Temple, TX Portland-Vancouver-Hillsboro, OR-WA Boulder, CO Las Vegas-Henderson-Paradise, NV Provo-Orem, UT Buffalo-Cheektowaga-Niagara Falls, NY Lincoln, NE Reading, PA Cape Girardeau, MO-IL Los Angeles-Long Beach-Anaheim, CA Richmond, VA Carson City, NV Lubbock, TX Rockford, IL Charlotte-Concord-Gastonia, NC-SC Madison, WI Saginaw, MI Cincinnati, OH-KY-IN Medford, OR San Francisco-Oakland-Hayward, CA Colorado Springs, CO Memphis, TN-MS-AR Seattle-Tacoma-Bellevue, WA Columbia, MO Miami-Fort Lauderdale-West Palm Beach, FL Sebastian-Vero Beach, FL Corpus Christi, TX Milwaukee-Waukesha-West Allis, WI South Bend-Mishawaka, IN-MI Decatur, IL Modesto, CA St. Louis, MO-IL Denver-Aurora-Lakewood, CO Monroe, LA Staunton-Waynesboro, VA Dothan, AL Montgomery, AL Tampa-St. Petersburg-Clearwater, FL Durham-Chapel Hill, NC Naples-Immokalee-Marco Island, FL Toledo, OH Evansville, IN-KY Nashville-Davidson--Murfreesboro--Franklin, TN Topeka, KS Flint, MI New Haven-Milford, CT Tuscaloosa, AL Florence, SC New Orleans-Metairie, LA Tyler, TX Fort Collins, CO New York-Newark-Jersey City, NY-NJ-PA Virginia Beach-Norfolk-Newport News, VA-NC Gainesville, FL Norwich-New London, CT Wichita, KS 5

6 Financial Arrangements: Gain Sharing Providers are still paid under FFS payment models as they are today (they may share in savings) Hospitals may have certain financial relationships with collaborators (they can share reconciliation payments and internal cost savings with collaborators) A providers must furnish services during episode to be a collaborator. Collaborators may include: Physicians and nonphysician practitioners Home health agencies Skilled nursing facilities Long-term care hospitals Physician group practices Inpatient rehabilitation facilities Providers or suppliers of therapy services 6

7 CJR Quality Measures Required measures: Hospital-level risk-standardized complication rate following elective primary THA and/or TKA (NQF #1550), an administrative claims-based measure HCAHPS survey measure Optional measures: Patient-reported outcome measures PROMIS Global or VR (Veterans RAND) 12 and HOOS Jr or HOOS Pain and Function, Daily Living Subscales/ KOOS Jr or Stiffness, Pain and Function, Daily Living Subscales 7

8 Beneficiaries Beneficiaries may still select any provider of choice with no restrictions. Beneficiaries may still receive any Medicarecovered service with no restrictions. Copayment does not change. Hospitals may offer certain items and services to beneficiaries during episode (but they may not be inducements). 8

9 Waivers The SNF 3-day rule can be waived if SNF is rated 3 stars or higher on Nursing Home Compare. The incident to rule for physician services can be waived to allow clinical staff of a physician to furnish home visits (only for patients not covered by HHA). Originating-site requirements for telehealth may be waived to allow services to be originated in patient s home. 9